Nursing Ethical Dilemma and Decision Making

Ethical Dilemma
Introduction
The following paper will narrate an ethical dilemma which has been faced by a nurse working is a local emergency department. The analysis of the dilemma will be done using Catalano’s (2009) ethical decision making algorithm for nurses. Various potential solutions to the dilemma will be discussed along with an examination of both the positive and negative consequences of the decision.
This ethical dilemma, faced by the emergency department nurse was related to a 93 year old patient who was transferred from an extended care facility. The patient had been diagnosed with Alzheimer’s disease. She was unable to eat or drink at all which was not enough to sustain her health. The patient would not give any response to any voice or touch. She was non-verbal. Her physician at the extended care facility had diagnosed her with failure to thrive. Her granddaughter was the power of attorney. The patient did not own an advanced directive. An emphasis had been laid by the patient’s family that she must be sent to the emergency department so she gets to have a feeding tube placed. The patient’s family told that they were assured that “the patient might get better is feeding tube was placed”. Now, the nurse was facing an ethical dilemma of supporting the patient’s right to a dignified demise and balancing the wishes of the family (Heiser, 2014).
Analysis of the dilemma
The decision making starts with assessment according to Catalino’s (2009) ethical decision-making algorithm. The first step involves the collection, analysis and interpretation of data. The decision involves determining which party will be influenced the most by the decision. The second step is to state the dilemma. In this case, the dilemma for the nurse is to fulfill the family’s desire and support the right of her patient to a dignified death. The third step involves collection of enough facts, including the potential threats to the patient’s life. The provided information is used to chalk down the possible outcomes (Deshpande, 2009).
In relation to the first step, the family’s wishes were assessed by the nurse. The nurse was told by the power of attorney that she wanted to get a feeding tube fixed. She further added that she was assured at the extended care facility that the patient would get better by placement of feeding tube. As per nurse’s assessment of the family’s understanding of Alzheimer’s disease, they did not have the knowledge that this disease was a progressive one. It is an irreversible form of dementia (Porth, 2010). They were unaware of the fact that there would be no effect on patient’s quality of life and progression of the patient’s Alzheimer’s disease by simply providing nutrition. The nurse must next consider the physical condition of the patient. The patient was not capable of communication or decision-making. She had a stage three decubitus ulcer on her coccyx. Placing a feeding tube would do nothing to improve patient’s quality of life.
The second step involves the dilemma of catering for the family’s desires or to support the patient’s right to a dignified death. Coming to the third step, there can be a possibility to have the tube fixed by a surgeon. But the other option would be offering hospice care to the patient and family. A third option can involve medically clearing the patient and returning her to the ECF. The nurse must take into consideration all the information gathered. This will help in solving the dilemma. The nurse’s further decision will depend on the possible solutions and outcomes.
Resolution of the dilemma
According to Blais & Hayes (2011), “responsible ethical reasoning involves rational thinking. It should not be based on emotions, intuition, fixed policies or precedents” (p. 61). One must take into consideration the ethical principles charted by their principal authorities and civil laws which are determined by the society and the government (Blais & Hayes, 2011). It has been recognized by The International Council of Nurses (2006) that promotion of health, alleviation of suffering and prevention of illness are counted as responsibilities of nurses (p. 1). They make sure that nurses must ensure that health care environments are safe and healthy for clients (p. 6).
The first possible solution to this dilemma would be to place the feeding tube. The family would be satisfied by this course of action and they would think that the patient’s life would be prolonged. The family expected the patient to recover from her current condition is nutrition was provided via the feeding tube and nutrition will be provided. There was no margin of improvement as the patient was suffering from advance Alzheimer’s disease. Nutritional intervention was not going to do any good. The family did not know that it was natural for patients to quit eating and drinking near the end of life (Dreyer, Forde, & Nortvedt, 2009). The feeding tube solution would calm the family down but it is not best for the patient.
Proposing the option of hospice care for her would be the second possible solution to advocate for the patient’s betterment. The nurse should find out the family’s agreement or disagreement with the patient’s wishes when the family is present (Gladding, 2000). She must communicate with the family along with a team of a physician, social worker, and chaplain as the patient is unable to communicate her wishes. So, the POA will have the final say regarding the decision. In certain situations, the patient’s family is contacted late, so these tough discussions take place when emotions are at peak (Dreyer et al., 2009). In ideal situations such discussion might take place when the patient is in extended care facility. But this rarely happens. The best option for the patient would be hospice care. The last solution to be considered can be sending the patient back to ECF. This would not help the patient or the family. This would upset the family as they would think that care has been denied to their loved one. Furthermore, this would delay the care that the patient needs at this time. This option would not be enough to make the nurse satisfied about catering for the patient’s needs (Heiser, 2014).
Positive and negative consequences of the decision
The solutions of every ethical bring along pros and cons with them.
In this case, the advantage of having the feeding tube placed is this action would satisfy the family’s desires. The pros of this action would be prolonging the suffering of the patient. The nutrition would not be of any help to the patient and would not improve her health. The positive consequence of offering hospice care would result in providing comfort to the patient in her finals days of life. This action’s negative consequence would be that the family would be upset knowing about hospice care and would not be ready to let their loved one leave at this time. Patient’s return to ECF would allow the physician and the nurse to encounter any potential conflict during such a difficult discussion with the family. The negative consequence of this action would be that it would not be helpful for the patient and it may further irritate or annoy the family at such a difficult time.
References
Blais, K., & Hayes, J. S. (2010). Professional nursing practice: Concepts and perspective (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Catalano, J. T. (2009). Nursing now! Today’s issues, tomorrow’s trends (5th ed.). Philadelphia: F.A. Davis.
Deshpande, S. P. (2009). A study of ethical decision making by physicians and nurses in hospitals. Journal of Business Ethics, 90(3), 387-397.
Dreyer, A., Forde, R., & Nortvedt, P. (2009, November). Autonomy at the end of life: Life prolonging treatment in nursing homes - relatives’ role in the decision-making process. Journal of Medical Ethics, 35(11), 672-677.
Gladding, S. T. (2000). Counseling: A Comprehensive Profession (4th ed.). Upper Saddle River, NJ: Merrill.
Heiser, G. (2014). End of life ethical dilemma. Journal of Excellence in Integrated Writing Courses at Wright State, 1(7), 1-5.
International Council of Nurses. (2006). The ICN code of ethics for nurses. Retrieved from http://www.icn.ch/icncode.pdf
Porth, C. M. (2010). Essentials of pathophysiology (3rd ed.). Philadelphia: Lippincott Williams& Wilkins.